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Title: Chemoprophylaxis Initiated Within 5 Days of Influenza Outbreak Reduces Illness, Death
URL: http://www.pslgroup.com/dg/224716.htm
Doctor's Guide
June 27, 2008

ARLINGTON, Va -- June 27, 2008 -- Influenza outbreaks were shorter, and resulted in fewer cases and deaths at long-term care facilities that started residents on preventive antiviral medications within 5 days of the first case, compared to those that started later, according to a study in the July 1 issue of Clinical Infectious Diseases.

A new study showed significant differences in outcomes when administering chemoprophylaxis within 5 days of detecting an influenza outbreak versus initiating medications more than 5 days after outbreaks were identified.

"Prompt initiation of chemoprophylaxis after identification of influenza A in a long-term care facility can decrease the severity of influenza outbreaks in those settings," said Marcie Rubin, Columbia University Mailman School of Public Health, New York, New York.

Rubin and personnel from the New York City Department of Health and Mental Hygiene's Bureau of Communicable Diseases looked at data from 52 outbreaks of influenza A in New York City long-term care facilities over the course of 3 influenza seasons. An outbreak was defined as either a single laboratory-confirmed case or a cluster of 2 or more cases of influenza-like illness.

Facilities that began prophylaxis within 5 days of the influenza outbreak's detection had outbreaks that lasted only about one third as long as those institutions that took longer to begin treating people (6.7 vs 18.3 days). Early intervention also led to far fewer cases (6.2 cases/100 residents vs 10.5 cases/100 residents), and deaths (0.45 deaths/100 ill residents vs 3.3 deaths/100 ill residents).

Given the striking benefits of a quick response, the authors recommend the development of strategies that might hasten an intervention. They suggest that facility staff increase their vigilance for diagnosing influenza cases. They also recommend that the process for collecting respiratory specimens for influenza detection be streamlined, with rapid testing and efficient communication of results from the laboratory to the staff.

The researchers studied outbreaks that occurred from 2001 to 2004, at which time amantadine was the frontline therapy for treatment and prophylaxis of influenza A. Since 2004, there has been increasing influenza resistance to amantadine and neuraminidase inhibitors have become the newest antivirals of choice. Further study is needed to determine whether rapid initiation of chemoprophylaxis with this class of antiviral drugs will result in similar positive impacts.


SOURCE: Infectious Diseases Society of America

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